Laparoscopic ileal ureteral substitution. Results of the first 40 operations


DOI: https://dx.doi.org/10.18565/urology.2018.4.5-12

A.D. Kochkin, E.A. Gallyamov, S.V. Popov, R.G. Biktimirov, A.E. Sanzharov, V.P. Sergeev, F.A. Sevryukov, I.N. Orlov, A.B. Novikov

1PRMU of Minzdrav of Russia, Nizhny Novgorod, Russia; 2Clinical Hospital at Nizhny Novgorod Railway Station of JSC «RZD», Nizhny Novgorod, Russia; 3I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University), Moscow, Russia; 4St. Luke’s Clinical Hospital, St. Petersburg, Russia; 5FMBC, FMBA of Russia, Khimki, Russia; 6FMBC, FMBA of Russia, Moscow, Russia; 7A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia; 8Multidisciplinary Medical Center of the Bank of Russia, Moscow, Russia
Introduction. Despite the twenty-year history of laparoscopic ileal ureteral substitution, the literature is lacking studies reporting its outcomes, and those few are mainly case reports. Besides, they usually describe surgery from combined access, when the ileal segment resection and ileo-ileal anastomosis are performed from mini-laparotomy, and the remaining stages are done endoscopically.
Aim. To conduct a multicenter retrospective analysis of our series of patients undergoing laparoscopic ileal ureteral substitution using only endoscopic access.
Material and methods. From 2010 to 2017, 48 ureters were replaced completely laparoscopically in 40 patients. Of them, 33 patients underwent total ureteric replacement, and the others had a subtotal ileal ureteral substitution. Video describing the operation technique is available on https://youtu.be/IeA60pSiUBE.
Results. The mean operating time was 335 minutes, and the estimated blood loss was 221 ml. Intraoperative complications (7.5%) were resolved during surgery. No patients required conversion to open surgery. There was no mortality. Postoperative Clavien III complications were observed in 7.5% of patients. The mean length of hospital day was 13.5 days. Functional results were followed from 6 months to 7 years.
Conclusions. The presented material is the largest available in the literature, and the results, including long-term functional outcomes, demonstrate the efficacy and safety of laparoscopic technologies in the treatment of extensive strictures and obliterations of the ureter.

About the Autors


Corresponding author: A. D. Kochkin – Ph.D., Teaching Assistant at the E.V. Shakhov Department of Urology, PRMU of Minzdrav of Russia, Urologist at the Department of Urology, Clinical Hospital at Nizhny Novgorod Railway Station of JSC «RZD», Nizhny Novgorod, Russia; e-mail: kochman@bk.ru


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